The long head of the biceps tendon is located at the center of the shoulder joint and is therefore more susceptible to injury due to its anatomical position. The long head of the biceps tendon is a long, ‘‘cord-like’’ structure that intra-articularly attaches (osculates) to the shoulder’s ‘‘cavity’’, known as the glenoid cavity, and connects part of the biceps brachii to the shoulder joint. Its role is to aid the rotator cuff in stabilizing the head of the humerus, which is the only bone of the upper arm.
Degeneration of the fibers in tendons is a common occurrence, particularly in the elderly, and leads to tendon tears. These tears can either be partial or total in cases of tendons that are split into two pieces. However, the two-head biceps tendon remains functional by virtue of the existing short head of the biceps tendon. Nonetheless, there is the possibility of a physical deformity known as ‘‘Popeye deformity’’, termed after a resemblance to the well-known cartoon character, which is identified by a rounded and enlarged muscle above the elbow.

Age, as well as activities that include lifting heavy weights and overusing the shoulder muscles, are the basic risk factors that are responsible for the development of this type of tendon tears. Tears of the long head of the biceps tendon are accompanied by a distinct sound (the majority of patients describe it as if hearing the flesh being ripped apart), sudden and intense pain on the anterior side of the shoulder, or even the elbow, as well as weakness, and difficulty in rotating the palm of the hand. In addition, there might be other injuries affecting the shoulder girdle, for example rotator cuff tears.

Popeye’s muscle ‘‘screams’’ the exact location of the injury, whereas partial tears are not as easy to detect. The detailed medical history of the patient is obtained by the orthopedist, followed by the patient’s clinical examination, in order to determine the possible existence of additional injuries. MRI scans are used to clarify the severity of the injury.
Appropriate treatment options are based on whether the injury is a partial or total tear, as well as the patient’s age and level of physical activities. Conventional treatment includes application of ice, anti-inflammatory drugs, rest and physiotherapy sessions. Surgical treatment is usually recommended in cases of persistent pain, as well as in cases of patients who participate in sports or manual labor. It involves the fixation of the tendon in its normal anatomical position (biceps tenodesis). The rehabilitation period is estimated to last a minimum of 3 months, and the patient must follow physiotherapy sessions and muscle strengthening exercises.

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